Quality of life assessment and HIV infection: A review (original) (raw)
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Assessment of quality of Life of HIV-Positive People on Antiretroviral Therapy
Background: HIV/AIDS has adverse impact not only on physical but also mental, social, and financial aspects of the infected individual. Quality of life (QOL) among these individuals is therefore becoming crucial for measuring commonly used endpoints. Objective: To study the quality of life (QOL) of HIV-positive people on antiretroviral therapy. Material and Methods: A hospital-based cross-sectional study was conducted among 100 adult HIV-positive patients at two tertiary care hospitals of Lucknow. Systematic random sampling was used to recruit patients. Quality of Life was assessed using WHOQOL-BREF scale. Results: Mean age of the PLHAs was 39.08±9.72 and majority (73.0%) of the study participants were male. QOL score were highest for physical health domain (10.45±1.35) followed by psychological domain (9.38±1.33), environmental domain (8.73±1.11) and social relationship domain (8.05±1.90) respectively. A significant difference (p<0.05) was observed in mean score for social relationship domain with subjects counselled within the last three months and those who were adherent to the treatment had a higher mean score of QOL mean score. Conclusions: The present study revealed intermediate level scores for quality of life for PLHAs. Therefore for improving each and every facet of quality of life all the psychological, emotional and medical needs should be properly addressed through combined efforts by health care providers as well as the community.
Quality of Life of HIV-Infected People Across Different Stages of Infection
Journal of Happiness Studies, 2010
Quality of life is an important component in the evaluation of the well-being of HIV-infected patients. In the present study, an attempt has been made to compare HIVinfected patients across the three stages namely, asymptomatic, symptomatic, and AIDSrelated conditions. This is a cross-sectional study. For this study, a total number of 90 subjects, 30 each in asymptomatic, symptomatic, and AIDS-related conditions, were taken. The study population consisted of HIV positive individual already enrolled in Voluntary Counseling and Testing Center,
2002
Objective: Brief utility measures are needed in clinical trials in addition to existing descriptive measures of health-related quality of life (HRQOL). We examined the reliability and validity of the EuroQol (EQ-5D) and MOS-HIV and their responsiveness to HIV-related clinical events. Methods: Subjects with advanced HIV disease (CD4 < 100) were enrolled in a randomized trial for CMV prophylaxis (n ¼ 990). The EQ-5D includes a weighted sum of five domains (EQ-5D Index) and a visual analog scale (EQ-VAS). The MOS-HIV has 10 subscales and physical (PHS) and mental health summary scores (MHS). Construct validity of the EQ-5D was tested based on hypothesized relationships to subscales of the MOS-HIV. Relative precision and responsiveness to adverse experiences and opportunistic infections (OIs) were compared for the two instruments. Results: Mean age of the patients was 38, 94% were male, 80% white, and 7% had injected drugs. Mean baseline scores for EQ-5D Index and EQ-VAS were 0.80 and 76.0, respectively, 28 and 4% reported maximum scores. Mean MOS-HIV subscales score ranged from 55 (role) to 84 (cognitive); mean PHS and MHS were 47.4 and 49.5, respectively. Correlations between MOS-HIV subscales and EQ-5D Index ranged from 0.45 (role) to 0.63 (pain); correlations with EQ-VAS ranged from 0.33 (cognitive) to 0.66 (health perceptions). Correlations between MOS-HIV PHS and MHS with EQ-5D Index were 0.61 and 0.58; and with EQ-VAS, 0.57 and 0.60, respectively. Responsiveness to adverse experiences was highest for MOS-HIV pain and PHS (effect sizes ¼ 0.9 and 0.4); pain had the highest relative precision (2.4) for adverse experiences; EQ-VAS had the greatest relative precision (1.6) for developing an OI. Conclusion: In these patients with advanced HIV disease, EQ-5D showed good construct validity, but there may be a ceiling effect for its EQ-5D Index component. EQ-5D was less responsive to adverse events than the MOS-HIV. However, the EQ-VAS was most sensitive to developing an OI and is likely to be a useful measure of HRQOL for generating QALYs in cost-utility studies involving patients with advanced HIV disease.
Health-related quality of life and virologic outcomes in an HIV clinic
2000
Objective: The purpose of this study was to describe the relationship between viral load and health-related quality of life (HRQOL) in a cohort of persons with human immunode®ciency virus (HIV) infection. Design: We evaluated HRQOL measurements in a clinical cohort of HIV-positive patients recruited from a university-associated HIV primary care clinic. HRQOL instruments included the medical outcomes surveyshort form-36(MOS-SF-36) from which mental and physical component summary scores (MCS and PCS) and subscale scores were calculated. Results: Signi®cant negative associations were found between viral load and SF-36 PCS, physical functioning (PF), role-physical (RP), bodily pain (BP), general health (GH), role-emotional (RE), and vitality (VT). Similar negative associations were found between CD4 cell count and SF-36 summary and subscale scores, with the notable exception of bodily pain. Multivariate analyses controlling for the eects of CD4 cell count and other clinical variables indicated viral load as an independent predictor of SF-36 PCS, RP, BP and VT scores. Conclusions: The relationship between viral load, a measure of HIV disease activity, and several dimensions of the SF-36, a patient-focused measure of HRQOL, appears to be strong and independent of CD4 cell count. These ®ndings suggest that having a lower viral load positively impacts the quality of life of HIV-positive patients.
The Indian Journal of Medical Research
Several instruments have been developed specifically to assess the quality of life (QOL) in HIV infected individuals. No information is available in this aspect from India. The present study was thus carried out to assess the QOL among HIV infected persons, to study their relationship with socio-demographic characteristics and stages of disease progression, and to examine change in QOL over time. One time assessment of QOL on 100 and repeat evaluation on 20 HIV infected persons enrolled in an ongoing longitudinal prospective study of clinical progression was done. Medical Outcome Study (MOS-QOL) core instrument was modified to suit the Indian cultural settings and interview-administered. The overall scale had Cronbach alpha 0.75. Instrument showed significant positive inter-domain correlations and linear association between QOL scores and CD4 counts. QOL was markedly affected in the domains of physical health, work and earnings, routine activities, and appetite and food intake. Wome...
Objective: To design a Health-related Quality of Life (HRQoL) instrument for HIV-infected people in the era of highly active antiretroviral therapy (HAART). Methods: The self-administered questionnaire was developed by an Italian network including researchers, physicians, people living with HIV, national institutions and community-based organizations (CBO) through several steps: (1) review of existing HRQoL literature and questionnaires for HIV-infected people; (2) selection of relevant domains measuring HRQoL in HIV-infected people, and identification of new domains related to new aspects of HRQoL concerning HAART-treated individuals; (3) conduction of two pre-test analyses in independent groups of Italian HIV-positive people (n @ 100) distributed throughout the country. The objectives of the first pre-test were to verify the usefulness of the questionnaire, to construct a form easily understandable by everyone, to define the domains and their significance; the second pre-test aimed at evaluating and reshaping the questionnaire based on a statistical analysis of the outcomes of first pre-test; (4) validation analysis. A large cohort of people with HIV infection was recruited for the last step. Results: The internal consistence reliability (Cronbach's a) was ‡0.70 for all domains. Most domains had Cronbach's coefficient >0.80. All domains demonstrated convergent and discriminant validity. The final version of ISSQoL includes two sections: HRQoL Core Evaluation Form (9 domains) and Additional Important Areas for HRQoL (6 domains). The ISSQoL was administered together with two additional forms: a Daily Impact of Symptoms Form and a Demographic Information Form. The Additional Important Areas for HRQoL include social support, interaction with medical staff, treatment impact, body changes, life planning, and motherhood/fatherhood. Conclusion: The data reported in the present paper provide preliminary evidence of the reliability and validity of the ISSQoL questionnaire for the measurement of HRQoL in HIV-infected people. The direct involvement of HIV-positive people in all the phases of the project was a key aspect of our work.
Global View of HIV Infection, 2011
Assessing the quality of life (QoL) of people living with HIV/AIDS has become increasing. From 1995 to 2003, more than 300 papers on the subject were published. This fact encourages researchers to question the existence of suitable assessment instruments. Virtually all existing instruments until 2003 had been developed in the USA (Skevington & O'Connell, 2003). To apply these instruments in countries in which English is not the vernacular language, the instruments were subjected to literal translations, without the worry of a cultural adaptation. In this wise, came the proposal to develop an instrument from sundry centers, located in different countries (Skevington & O'Connell, 2003). The fact that there is no consensus on the QoL concept is a major problem in developing instruments to assess the QoL, while it is not possible to state clearly what elements these instruments are assessing (Fleck, 2008). From this premise, the starting point to build the instrument for QoL assessment of the World Health Organization (WHO) was to conceptualize QoL. In the concept adopted, QoL is understood as "individuals' perceptions of their position in life in the context of the culture and value systems in which they live and in relation to their goals, expectations, standards and concerns" (The WHOQOL Group, 1998a, p. 25). In face of this concept, WHO embarked on building the World Health Organization Quality of Life (WHOQOL) instruments, which assess QoL globally, e.g. WHOQOL-100 and WHOQOL-bref, and due to specific aspects, e.g. WHOQOL-HIV, WHOQOL-OLD, and WHOQOL-SRPB. One of these instruments, the WHOQOL-HIV, used to assess the QoL of HIV carriers, is the object of this study. Starting from the fact that 95% of people infected with HIV did not live in the USA but in developing countries of Asia, Latin America, and sub-Saharan Africa, WHO has developed a tool to assess the QoL directed to such audience. The instrument was designed based on the premise that a multidisciplinary approach, involving centers in several countries, would allow for greater dissemination of the developed instrument (O'Connell, 2003). The WHOQOL-HIV is a complementary module for WHOQOL-100 instrument, and was also translated into other languages and validated in sundry studies, among which are a
Assessment of quality of life and its associated factors among people living with HIV/AIDS
HIV & AIDS Review
Introduction: Acquired immunodeficiency syndrome (AIDS) has evolved from a mysterious illness to a global pandemic which has infected tens of millions of people. Assessing health-related quality of life (HQOL) is useful for documenting the patients' perceived burden of chronic disease, tracking changes in health over time, assessing the effects of treatment and quantifying the return on health care investment. The study aimed to assess the quality of life and its associated factors in patients with HIV/AIDS. Material and methods: It was a hospital-based observational study conducted at the anti-retroviral therapy centre of the civil hospital, Nashik District. A total of 100 participants with confirmed HIV/ AIDS were included. The WHOQOL-HIV BREF instrument was used to assess the quality of life of people living with HIV/AIDS (PLHAs). Multivariate logical regression was used to study the factors affecting the quality of life of PLHAs. Results: The mean scores of HQOL was highest in the domain of spirituality (15.99) followed by the physical domain (14.71), level of independence (14.45), social relationships (14.04), psychological domain (13.26), and environment (13.04), and the overall perception of quality of life and general health perception's scores were 13.28 and 12.84. Conclussions: These findings highlight the need for enhanced socio-psychosocial support and a better environment for improving the health-related quality of life among PLHAs.